Doctoral Degrees (School of Nursing)

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Browsing Doctoral Degrees (School of Nursing) by Advisor "Roets, L."

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    A framework to improve postnatal care in Kenya
    (University of the Free State, 2015-01) Chelagat, Dinah; Roets, L.; Joubert, A.
    English: More than half a million women encounter complications during childbirth annually with a significant number of fatalities (UNFPA 2009: Online). It is estimated that 1,000 girls and women die in pregnancy or child birth each day (The White Ribbon Alliance 2010: Online; Ashford, Wong and Sternbach 2008:457-473). Ashford et al. (2008) further state that almost 40% of women experience complications after delivery with about 15% of these women developing potentially life-threatening complications. Maternal mortality can occur either during the antenatal, intrapartum or postnatal period. However, strategies to reduce maternal mortality have focused on the antenatal and the intrapartum periods (Ministry of Health, Kenya 2006: 52). Maternal mortality can be reduced with improved postnatal care by skilled health care professionals , the majority of whom are the midwives in many low and middle income countries (Senfuka 2012: Online; UNFPA 2011c: Online). Maternal mortality is greatest during the postnatal period which remains the most neglected stage of maternal care especially in the LMICs Kenya included (Safe motherhood 2011: Online). The aim of this study was to develop a Framework to improve postnatal care in Kenya. The study was accomplished in three phases whereby the first objective was to determine factors contributing to the current state of postnatal care services in Kenya which was undertaken in Phase 1.This objective was achieved through data collection where by 258 midwives completed a self-administered questionnaire plus a checklist used in 37 hospitals to assess the availability of physical resources required in the provision of postnatal care. Data analysis revealed that shortage of midwives exists in all the hospitals utilised for the study with a nurse midwife ratio of more than 10. It was further observed that midwives received incomplete orientation on being posted to the maternity units/postnatal wards hence their inability to provide quality postnatal care services. Policies and guidelines were reported to be inaccessible by a majority of the midwives and that cultural and religious beliefs of clients were deemed to have some influence on the provision of the postnatal care. The Nominal Group Technique was used among 13 Reproductive health coordinators in phase 2 to identify the strategies they deemed if employed would improve postnatal care in Kenyan hospitals.The six strategies identified in order of priority are capacity building, data management, quality assurance, human resource management, supportive supervision and coordination of postnatal care activities. The objective of this phase of study was achieved as the NGT process was followed scientifically and results obtained (the strategies) contributed to the development of the Framework as one of the important components of The Theory of Change Logic Model. The third objective and final phase of the study was to develop a Framework to aid in improving postnatal care in Kenya. Development of the framework was accomplished by triangulating the results obtained from Phases 1 and 2. The Framework development was guided by the Theory of Change Logic Model which describes the casual linkages that are assumed to occur from the start of the project to the goal attainment (Frechtling 2007: 5; Taylor-Powell and Henert 2008: 4). The components of the Theory of Change logic by Kellogg (2004: 28) are the problem or issue, community needs, desired results, influential factors, strategies and assumptions (Kellogg 2004: 28). The draft Framework was presented to the Reproductive Health coordinators for validation in a meeting held on 12th March 2014. The stakeholders who are the Reproductive Health coordinators added their expert input to the components of the Theory of Change Logic Model during the validation process leading to a complete Framework aimed at improving postnatal care in Kenya.
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    Die onderrig van professionele praktyk in die geïntegreerde, vierjaar verpleegkunde program
    (University of the Free State, 2009-08-05) Botha, Delene Ellen; Roets, L.
    English: Florence Nightingale was 206 years ago of opinion that Nursing is not a household sercide or charity service and that nurses should be educated Nursing today is acknowledged as a profession and the aim of Nursing Education, as formulated by the South African Nursing Council (SANC) is that student nurses should be holistically developed. In contrast to 20 years ago, professional nurses today have to function autonomously, scientifically, within legal and ethical frameworks as well as cultural congruently. It is no more expected from professional nurses to only act on doctors’ prescriptions, to perform technical procedures or to only observe patients and record information. They have to practice as independent practitioners. In accordance to SANC requirements, students are educated in the science and art of Nursing, other related sciences as well as Ethics and Professional Practice (Björkstrom, et al., 2006:505; Davis, Tschudin & de Raeve, 2006:21; Jormsri, Kunaviktikul, Ketefian & Chaowalit, 2005, intyds; Gastmans, 2002:intyds; Taft, 2000:intyds; Hussey, 1996:251) When students apply for registration with SANC after they have completed their studies, they actually declare that they comply with the autonomy, responsibility, values and norms of Nursing and are prepared to practice accordingly. This implies that they declare that they have developed a professional identity. Development of professional identity is an ongoing process and has to be addressed, amongst others, in the teaching of Ethos and Professional Practice. The aim of this study was to understand what the nature of Professional Practice is and to assess the process of teaching of Ethos and Professional Practice at national level. The research was explorative, descriptive and explainatory in nature and both quantitative techniques and qualitative techniques were used for gathering of data. Data gathering was done in different phases, namely analysis of disciplinary hearings, focus groups, literature analysis as well as telephone interviews. The results indicate that the majority of nursing institutions teach the content appropriate to SANC’s guidelines. These guidelines were drafted in 1985 and is currently being revised. The profile of the students who are entering Nursing has changed. It is therefore a concern that traditional teaching techniques, such as lectures, class room discussions as well as written assessment are still mostly used in teaching Ethos and Professional Practice. These techniques do not improve development of professional identity. The time allocated to the teaching of [Ethos and] Professional Practice is problematic if the development of professional identity is required. Teaching and following-up of students with regard to [Ethos and] Professional Practice in the clinical setting was found to be insufficient. Taking this into account as well as the fact that there are not sufficient positive role models present, make it impossible for students to develop a professional identity. Students who do not develop a professional identity have a greater risk of unprofessional conduct. A framework, aimed at teaching [Ethos and] Professional Practice in order to develop a professional identity was compiled. This aims to enhance professional conduct.